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Original article
Impact of prosthesis–patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival
  1. William Y Shi1,
  2. Cheng-Hon Yap2,3,
  3. Philip A Hayward1,
  4. Diem T Dinh2,
  5. Christopher M Reid2,
  6. Gilbert C Shardey2,4,5,
  7. Julian A Smith4,5
  1. 1Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
  2. 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  3. 3Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
  4. 4Department of Cardiothoracic Surgery, Monash Medical Centre, Melbourne, Australia
  5. 5Department of Surgery, Monash University, Melbourne, Australia
  1. Correspondence to Dr Cheng-Hon Yap, Department of Cardiac Surgery, Bristol Heart Institute, Malborough Street, Bristol Royal Infirmary, Bristol BS28HW, UK; cheng-hon.yap{at}


Background Prosthesis–patient mismatch (PPM) is characterised by the effects of inadequate prosthesis size relative to body surface area (BSA). It is uncertain whether PPM after mitral valve replacement impacts upon clinical outcome. This was examined in an Australian population.

Methods From 2001 to 2009, 1006 mechanical and bioprosthetic mitral valves were implanted across 10 institutions. Effective orifice areas (EOA) were obtained from a literature review of in vivo echocardiographic data. Absent, moderate and severe PPM was defined as an indexed EOA (EOA/BSA) of >1.20 cm2/m2, >0.90 to ≤1.20 cm2/m2 and ≤0.9 cm2/m2, respectively. Early outcomes and 7-year survival were compared between these three groups.

Results PPM was absent in 34%, moderate in 53% and severe in 13% of patients. Patients with PPM were more likely to be male (42% vs 52% vs 62%, p<0.0001) and obese (14% vs 20% vs 56%, p<0.0001). Postoperatively there was similar 30-day mortality (5% vs 5% vs 6%, p=0.83) and early any mortality/morbidity (24% vs 27% vs 29%, p=0.40). Seven-year survival was similar between groups (72±4.1% vs 76±3.2% vs 69±10.3%, p=0.76). PPM did not predict adverse events after logistic and Cox regressions with and without propensity score adjustment. Subgroup analyses of those with isolated mitral valve surgery, patients with preoperative congestive heart failure and non-obese patients failed to show an association between PPM and mid-term mortality.

Conclusions Overall, PPM was not associated with poorer early outcomes or mid-term survival. Oversizing valves may be technically hazardous and do not yield superior outcomes. Easier implantation by appropriate sizing appears justified.

  • Surgery-valve
  • prosthetic heart valve
  • prosthesis-patient mismatch
  • mitral valve
  • mitral regurgitation
  • mitral stenosis

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  • This paper was presented on 22 March 2011 at the Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland, Excel London, London, UK.

  • Funding The Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) National Cardiac Surgery Database is funded by the Department of Human Services, Victoria and the Health Administration Corporation (GMCT) and the Clinical Excellence Commission (CEC), New South Wales, Australia.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.